Bonitas arrived at Thursday’s annual results presentation with plenty to celebrate. A record R1.8 billion surplus. Reserves of R10.8bn. A solvency ratio of 36.9%. Membership growth for a third consecutive year. By almost every financial measure, 2025 was Bonitas’s strongest financial year.
Yet the mood in the room was muted.
Coming just two months after one of the most turbulent administrator transitions in the medical scheme industry’s recent history, principal officer Lee Callakoppen opened on a somewhat measured note. Rather than unpacking the financial performance, he spent much of his presentation explaining the decisions that had brought Bonitas to this point.
For weeks, Bonitas had been dealing with the fallout from its 1 June “clean cut” transition from Medscheme to Momentum Health Solutions as administrator and Private Health Administrators (PHA) as its managed-care organisation. Members struggled to obtain hospital authorisations, access chronic medication, resolve claims, and reach call centres.
Callakoppen argued that the transition could not be judged on the past two months alone.
Instead, he took the audience back to 2022, when Bonitas began reshaping the scheme to broaden its reach, improve affordability, and strengthen its long-term sustainability. According to Callakoppen, 92% of Bonitas’s client base had since been replaced with a different membership profile, creating what he described as the need for closer alignment between the organisations supporting the scheme.
“The complete ecosystem of Bonitas remains relevant and sustainable for our members,” he said. “A consolidated focus and approach of alignment of service providers is essential.”
He described the appointment of Momentum Health Solutions and PHA as the next step in that strategy. The change, he said, was intended to improve technology, member value, choice, and the ease of doing business. Achieving those goals, he added, sometimes required “courageous and robust decisions”.
But Callakoppen acknowledged that the transition had come at a cost.
Although Bonitas had maintained what he described as one of the strongest trust indices in the industry over the past five to six years, “the current experience and change has impacted it”.
“I am very mindful of the impact of change and the erosion of trust.”
For the first six weeks after the cutover, Bonitas tracked member “sentiments” almost daily. Dedicated “war teams” met every morning and evening throughout the first month – and on some Sunday evenings – to deal with problems as they emerged.
“A change of this size would never be smooth sailing, but it’s about how we respond,” he said.
The scale of the operation was reflected in the numbers.
During the first six weeks after the transition, Bonitas paid R2.46bn in healthcare claims, processed R9.8 million in medical savings refunds and R74m in broker commission. It handled more than 463 000 customer calls, 47 306 chats and 335 662 emails, answered 53 630 provider calls and 31 296 broker calls, processed more than 6 000 new business applications, supported 219 889 members receiving chronic medication, issued 101 602 hospital authorisations, and maintained contracts with more than 8 000 general practitioners.
Customer calls averaged seven minutes and 15 seconds, while broker calls averaged just over 11 minutes.
“It’s not something we are happy with,” Callakoppen said. “It’s not something that is acceptable for what we expect as Bonitas.”
He also urged the audience not to lose sight of the people behind the transition. Nearly 1 000 new employees had been recruited as part of the move, many of them stepping into call centre roles for the first time.
“It’s not an excuse. It’s not one of trying to find sympathy,” he said. “But it’s one of ensuring that we appreciate the context in which this change is taking place.”
Callakoppen also referred to tariff misalignments, differing clinical protocols, and duplicate interactions across Bonitas’s digital platforms as challenges that surfaced after the transition. While acknowledging those issues, he said the scheme and its service providers had “line of sight” on the problems and were working to resolve them.
But he cautioned that there was little time to lose.
“Our time is running out.”
He said the message had been communicated across the organisation.
“The urgency needs to be there to restore and deliver on this mammoth responsibility that we are tasked with.”
The Council for Medical Schemes (CMS) has confirmed to Moonstone that it is conducting a section 43 inquiry into Bonitas’s appointment of Momentum Health Solutions as administrator. The CMS said such inquiries are initiated whenever a medical scheme appoints a new administrator to assess compliance with Board Notice 73.
Read: CMS sets end-August target for Bonitas procurement investigation
Record results built on membership growth, cost management, and investment returns
The mood shifted as chief financial officer Vurhonga Rikhotsa (pictured) took the stage.
“Last year I said I was excited. This year, I’m even more excited,” she said before turning to the numbers behind Bonitas’s 2025 performance.
Bonitas reported a record surplus of R1.8bn, up from R133.9 million in 2024. Member reserves increased from R9bn to R10.8bn, while the scheme ended the year with a solvency ratio of 36.9% – well above the statutory minimum.
Membership growth was a key contributor, although the year did not begin smoothly.
On 1 January 2025, Bonitas lost a large employer pay point comprising about 8 000 principal members. By year-end, it had more than recovered those losses through organic growth, ending 2025 with 369 186 principal members – a net increase of 10 430, or 2.9%.
Much of that growth came from the scheme’s lower-cost “new generation” options, which attracted younger members and larger families. As a result, Bonitas ended 2025 with an average beneficiary age of 36.2 years (compared with 36.8 across the open-scheme industry), an average family size of 2.04 (2.01), and a pensioner ratio of 11.8% (12%), while 63% of its membership came through corporate employers.
The changing membership profile also supported Bonitas’s underlying operating performance. Rikhotsa said a younger membership base and lower pensioner ratio help to contain claims, while a stronger corporate membership mix further supports the scheme’s financial sustainability.
Excluding investment income, the insurance service result – which measures the gap between contribution income and the cost of providing healthcare benefits – improved significantly during the year. The insurance service deficit narrowed from almost R1bn in 2024 to R382m in 2025, while the number of loss-making benefit options fell from eight to seven.
One example was the turnaround of the Primary option.
Bonitas introduced a hospital network, allowing it to negotiate lower tariffs for planned procedures while preserving members’ freedom to use any hospital in an emergency. Together with preventative care programmes, managed-care initiatives and changes to benefit design, those interventions helped to reduce the claims ratio from 95.9% to 94.3%.
Across the scheme, Bonitas said managed-care initiatives, strategic purchasing, and provider negotiations generated R1.6bn in savings without reducing members’ benefits.
Hospital tariff negotiations accounted for R566m of those savings, making them the single biggest contributor. Recoveries from fraud, waste, and abuse also increased from R46.2m to R55.3m.
The biggest driver of the record surplus, though, was investment performance. Investment income almost doubled, increasing from R1.4bn in 2024 to R2.6bn in 2025 and delivering a return on investment of 20.8%. Strong returns from local equities, bonds and listed property all contributed to the result.
After elective procedures slowed sharply during the Covid-19 pandemic, medical schemes accumulated unusually high reserves. Bonitas’s solvency ratio rose to 41.3% in 2022 and 41.5% in 2023, before easing to 38.6% in 2024 and 36.9% in 2025. The statutory minimum is 25%.
Rather than maintaining those elevated reserves, the board decided gradually to return some of that capital to members by moderating contribution increases. Rikhotsa said the decline reflected that deliberate strategy rather than any weakening of the scheme’s financial position. Based on current trends, Bonitas expects the ratio to decline to 34.4% in 2026, while remaining above its long-term target of 30%.
For brokers, the value statement offered a useful snapshot of how members’ contributions were ultimately distributed.
Of the approximately R25bn generated through contributions and investment income, R22bn was paid in healthcare benefits. Brokers received R429m in commission, while Bonitas’s administration and managed-care partners received about R1.8bn for services provided to the scheme. Non-healthcare expenditure amounted to 9.2% of risk contributions, below the industry average of about 11%.
The 2025 results close the final full financial year under Medscheme.
When Bonitas returns to present its 2026 results next year, the discussion is likely to extend well beyond surplus, solvency, and membership growth. The numbers will show whether the scheme has been able to preserve the financial momentum built under its previous administrator while delivering the operational stability and member experience promised by the new operating model.
